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Observations on the use of the ultra high-speed air turbine handpiece
OPERATIVE
DENTISTRY
OBSERVATIONS ON THE USE OF THE ULTRA HIGH-SPEED AIR TURBINE HANDPIECE ROBERT
W. FISCHER, D.D.S.
Cleveland, Ohio HE USE OF AN air turbine handpiece, operating at speeds of about 250,000 r.p.m., is quite a radical departure from traditional procedure, and many questions naturally arise about it. Is it difficult to adapt to these high speeds? What are the reactions of patients to it ? How does it affect the dentist? Is it really so different ? For the dentist who had previously been operating with rotational speeds no higher than 25,000 r.p.m., the ultra high-speed handpiece is a thrilling experience. To be able to remove tooth structure as quickly as one could desire without heat, vibration, or tension is a delight. For those of us who spend a large part of each day drilling on tooth structure, this formerly difficult task becomes simple and almost pleasant. The patient is immediately aware of the lack of vibration and the freedom from heavy pressures from the cutting instrument. With the routine use of local anesthesia which has substantially eliminated pain during operative procedures, it has been vibration and pressure which have continued to make operative dentistry unpleasant. Now, after experiencing tooth reduction with the air turbine handpiece, patients invariably say that they no longer dread the next visit. Aside from the reduced unpleasantness of the new cutting instrument, the most gratifying feature is the fact that better dentistry can be performed. There no longer is any reason to settle for anything less than perfect preparations. It is so easy to have definite line angles, precise shoulders, and adequate tooth. structure removal that it would be folly to have less. I have been asked, “What percentage of the time is the air turbine handpiece used ?” I now use the conventional handpiece speeds only ( 1) for slices on the mesial and distal surfaces, using the straight handpiece with a disk ; and (2) for the removal of that last bit of decay in very deep cavities, when there is a possibility of a pulp exposure. Both carbide burs and diamond points are used with the air turbine handpiece. However, a nice feature is that a very limited armamentarium is required.
T
Received for publication
March 5,1858. 803
Volume 9 Number 2
ULTRA
HIGH-SPEED
AIR
TURBINE
HANDPIECE
303
Only small instruments are used because, at such high speeds, any instrument with a large outer circumference would develop an uncontrollable torque. Furthermore, even the slimmest of cutting points removes tooth structure so fast that it is rmnecessary to resort to the cumbersome sizes. The speed with which preparations can be made at the ultra high speeds borders on the fantastic. Occlusal and gingival cavities can be prepared in a matter of seconds. Two and three surface preparations may take a minute or two. For the dentist who makes full crown preparations for rehabilitation work, the ultra high speeds are especially effective. An entire quadrant may be prepared in a matter of minutes without the patient and the dentist feeling as if they have come through a major ordeal. DISADVANTAGES
Some unpleasant features of ultra high speeds have become apparent in tny experience. Drilling at these very high speeds is not painless. Far from that, it is more painful than drilling at lower speeds. Whereas, the dentist using the conventional rotational speeds can carefully peck away at the more sensitive dentine, gradually removing the last bits of decay, the air turbine user must attack these sensitive spots with undiminished speed, and it hurts. In fact, patients report a more intense, exquisite pain than that experienced at slower speeds. Also, the chilling action of the escaping air in itself is enough to be unpleasant. For the patient who “prefers to get it over with” without a local anesthetic, the preparation can, of course, be done very quickly with the air turbine handpiece. However, because of the additional pain due to the high speeds, I find myself using more local anesthetics than before. Although the air turbine handpiece is not inordinately noisy, it does emit a high-pitched whine. This is a little startling to the patient at first, and it is particularly unsettling to young children. This disadvantage usually can be overcome, however, if a moment is taken to demonstrate the noise to the patient before the handpiece is applied to the tooth. Because of the great ease with which tooth structure is removed, and the corresponding decrease in tactile sense, there exists a slight danger of producing accidental pulp exposures. Consequently, in very deep cavities, I find it worth the extra precaution to revert to the use of the conventional handpiece to remove the final deepest bit of decay. CONCLUSION
The air turbine handpiece is a device of great value to ease the burden of the dentist and to make good dentistry more bearable to the patient. UNIVERSITY-CEDAR MEDICAL BLDG. 10900 CARNEGIE AVE. CLEVELAND 6. OHIO
DENTISTRY
OBSERVATIONS ON THE USE OF THE ULTRA HIGH-SPEED AIR TURBINE HANDPIECE ROBERT
W. FISCHER, D.D.S.
Cleveland, Ohio HE USE OF AN air turbine handpiece, operating at speeds of about 250,000 r.p.m., is quite a radical departure from traditional procedure, and many questions naturally arise about it. Is it difficult to adapt to these high speeds? What are the reactions of patients to it ? How does it affect the dentist? Is it really so different ? For the dentist who had previously been operating with rotational speeds no higher than 25,000 r.p.m., the ultra high-speed handpiece is a thrilling experience. To be able to remove tooth structure as quickly as one could desire without heat, vibration, or tension is a delight. For those of us who spend a large part of each day drilling on tooth structure, this formerly difficult task becomes simple and almost pleasant. The patient is immediately aware of the lack of vibration and the freedom from heavy pressures from the cutting instrument. With the routine use of local anesthesia which has substantially eliminated pain during operative procedures, it has been vibration and pressure which have continued to make operative dentistry unpleasant. Now, after experiencing tooth reduction with the air turbine handpiece, patients invariably say that they no longer dread the next visit. Aside from the reduced unpleasantness of the new cutting instrument, the most gratifying feature is the fact that better dentistry can be performed. There no longer is any reason to settle for anything less than perfect preparations. It is so easy to have definite line angles, precise shoulders, and adequate tooth. structure removal that it would be folly to have less. I have been asked, “What percentage of the time is the air turbine handpiece used ?” I now use the conventional handpiece speeds only ( 1) for slices on the mesial and distal surfaces, using the straight handpiece with a disk ; and (2) for the removal of that last bit of decay in very deep cavities, when there is a possibility of a pulp exposure. Both carbide burs and diamond points are used with the air turbine handpiece. However, a nice feature is that a very limited armamentarium is required.
T
Received for publication
March 5,1858. 803
Volume 9 Number 2
ULTRA
HIGH-SPEED
AIR
TURBINE
HANDPIECE
303
Only small instruments are used because, at such high speeds, any instrument with a large outer circumference would develop an uncontrollable torque. Furthermore, even the slimmest of cutting points removes tooth structure so fast that it is rmnecessary to resort to the cumbersome sizes. The speed with which preparations can be made at the ultra high speeds borders on the fantastic. Occlusal and gingival cavities can be prepared in a matter of seconds. Two and three surface preparations may take a minute or two. For the dentist who makes full crown preparations for rehabilitation work, the ultra high speeds are especially effective. An entire quadrant may be prepared in a matter of minutes without the patient and the dentist feeling as if they have come through a major ordeal. DISADVANTAGES
Some unpleasant features of ultra high speeds have become apparent in tny experience. Drilling at these very high speeds is not painless. Far from that, it is more painful than drilling at lower speeds. Whereas, the dentist using the conventional rotational speeds can carefully peck away at the more sensitive dentine, gradually removing the last bits of decay, the air turbine user must attack these sensitive spots with undiminished speed, and it hurts. In fact, patients report a more intense, exquisite pain than that experienced at slower speeds. Also, the chilling action of the escaping air in itself is enough to be unpleasant. For the patient who “prefers to get it over with” without a local anesthetic, the preparation can, of course, be done very quickly with the air turbine handpiece. However, because of the additional pain due to the high speeds, I find myself using more local anesthetics than before. Although the air turbine handpiece is not inordinately noisy, it does emit a high-pitched whine. This is a little startling to the patient at first, and it is particularly unsettling to young children. This disadvantage usually can be overcome, however, if a moment is taken to demonstrate the noise to the patient before the handpiece is applied to the tooth. Because of the great ease with which tooth structure is removed, and the corresponding decrease in tactile sense, there exists a slight danger of producing accidental pulp exposures. Consequently, in very deep cavities, I find it worth the extra precaution to revert to the use of the conventional handpiece to remove the final deepest bit of decay. CONCLUSION
The air turbine handpiece is a device of great value to ease the burden of the dentist and to make good dentistry more bearable to the patient. UNIVERSITY-CEDAR MEDICAL BLDG. 10900 CARNEGIE AVE. CLEVELAND 6. OHIO